Acupuncture is one of the oldest and most commonly used medical procedures in the world. It involves inserting fine needles into specific points in the body to restore and maintain health. Acupuncture is commonly used to control pain and other symptoms associated with a number of medical conditions.
Acupuncture is a component of traditional Chinese medicine. According to this ancient system, the body is a balance between two opposing forces, yin and yang. When the balance between these forces is disrupted, it leads to a blockage of qi, the vital energy or life force responsible for a person’s spiritual, emotional, mental and physical balance. This blockage is believed to result in illness and pain.
Qi (pronounced “chee”) is believed to travel through the body in pathways known as meridians. Each pathway is thought to correspond to one specific organ or group of organs. To relieve pain and restore health, specific points along the meridians (acupuncture points) are stimulated. The most commonly practiced acupuncture technique involves the insertion of hair-thin, solid, sterile metallic needles into the specific acupuncture points. Less often, these points may be stimulated with pressure (acupressure), herbal compounds, laser, therapeutic ultrasound, heat or electricity.
Most patients feel no pain or minimal discomfort as the needles are placed. Some may feel a pinch or sting accompanied by a sensation of warmth or tingling. The number and placement of the needles is based on the condition being treated. Usually, fewer than a dozen needles are inserted. The time the needles are left in place and the depth of insertion also vary. In most cases, the needles are left in place for 15 to 30 minutes. In some instances, the needles may be inserted just for stimulation and immediately removed.
Although researchers have been unable to explain the effectiveness of acupuncture in terms of conventional medicine, experts believe its effectiveness may be due to stimulation of the central nervous system, release of natural opioids or changes in body function.
According to the National Health Interview Survey, about 8.2 million American adults have had acupuncture. In recent years, many physicians in Western medicine have adopted acupuncture as added treatment for medical conditions.
Acupuncture is commonly used to relieve chronic pain associated with a number of conditions, including:
Back pain, neck pain and other joint pain
Headaches
Osteoarthritis and other forms of arthritis
Pelvic pain
Fibromyalgia
Carpal tunnel syndrome
It is also frequently used to treat symptoms associated with cancer or cancer treatments, such as fatigue and nausea. It is becoming popular for treatment of acute pain (e.g., pain control during minor procedures). Acupuncture sessions may take place over a few days, several weeks or longer. The treatments may be performed alone or in combination with other elements, such as herbal supplements or physical therapy.
The effectiveness of acupuncture depends upon the medical condition and the expertise of the performer, and varies from person to person. For some people, acupuncture provides immediate relief. Other patients do not notice an improvement until several sessions have been conducted. Many people report no effect.
As with most treatments, there are a number of risks associated with acupuncture. Potential risks include infection, bleeding or an organ puncture. To minimize these risks, patients are encouraged to choose an acupuncturist with care. In the United States, acupuncture is offered by physicians, dentists and certified acupuncturists.
About acupuncture
Acupuncture is used to treat pain from chronic and acute conditions. It is a component of traditional Chinese medicine (TCM).
Today, acupuncture is one of the oldest and most commonly used medical procedures. Although it originated in China more than 2,000 years ago, it did not gain widespread recognition in the United Stated until the 1970s.
TCM is a system of medicine in which the body is seen as a balance of two opposing forces – yin and yang. The balance between yin (the cold, slow or passive principle) and yang (the hot, excited or active principle) controls the flow of qi (pronounced “chee” and sometimes spelled “chi”). Qi is the vital energy or life force responsible for a person’s spiritual, emotional, mental and physical balance. When the internal balance of yin and yang is disrupted, the imbalance leads to blockage of qi. According to Chinese theory, blockage of qi results in illness or pain.
Qi flows through energy pathways (meridians) in the body. There are about 12 main meridians and eight secondary meridians in the body. Each meridian is believed to correspond to one specific organ or group of organs.
The theory behind acupuncture is that stimulating specific points along the meridians where the energy pathway is close to the skin can correct the flow of qi. Ultimately this restores health and relieves pain, according to adherents. It is believed that there are more than 200 of these acupuncture points on the body.
There are a number of techniques used to stimulate acupuncture points. The most commonly used form of acupuncture involves the placement of hair-thin, solid, metallic needles at specific locations on the skin. Acupuncture points can also be stimulated with pressure (acupressure), laser, ultrasound, heat (thermotherapy) or electricity.
In 1996, the U.S. Food and Drug Administration (FDA) approved acupuncture needles for use by licensed professionals. Although the use of acupuncture needles has gained approval in the United States and studies have documented the procedure’s effects, researchers have been unable to explain the effectiveness of acupuncture within the framework of conventional medicine. Theories include:
Stimulation of the central nervous system. Acupuncture may stimulate the central nervous system (brain and spinal cord) to release neurotransmitters and neurohormones. These substances activate the body’s natural healing process.
Release of natural opioids. Acupuncture may trigger the release of endorphins, a chemical component of the body’s natural pain control system. It may also cause the release of immune system cells at specific areas of the body.
Changes in body function. Changes occurring in the central nervous system as the result of acupuncture may alter the regulation of blood pressure, blood flow and body temperature.
Many studies on acupuncture have been done. They are often hampered by study size and design but have shown promising results in treating conditions such as postoperative dental pain and nausea and vomiting after surgery or chemotherapy, according to the U.S. National Institutes of Health (NIH).
Several studies have indicated that, along with traditional acupuncture, “sham” or “minimal” acupuncture (superficial insertion of needles at non-acupuncture points) can be effective in easing conditions such as tension headaches and migraines. Some research suggests that a positive response to sham acupuncture may be a placebo effect, meaning patients feel better because they want to believe the treatment has helped them.
According to the 2002 National Health Interview Survey, the most recently available to include information about acupuncture, about 8.2 million American adults have had acupuncture. Of these patients, about 2.1 million had used acupuncture in the previous year. The U.S. government does not yet offer more recent statistics on use of acupuncture but notes that interest is growing. A number of variations on acupuncture have been performed within the United States even though the scientific rationale behind the practice still needs to be established.
Acupuncture may be used as a stand-alone treatment or in combination with pain medication or other forms of treatment, such as physical therapy or manipulation therapy. Patients interested in pursuing acupuncture as a treatment option are encouraged to discuss the method with their physician. Physicians will evaluate the patient’s medical history and current condition to determine whether acupuncture is a suitable form of treatment.
In the United States, acupuncture is offered by physicians, dentists and certified acupuncturists. Most states have implemented training requirements for certification and licensure, but these standards vary from state to state, according to the NIH. Patients seeking a practitioner are encouraged to choose their professional with care. Physicians and national acupuncture organizations can offer referrals. In some cases, patients may be referred to a professional with experience treating their specific condition or symptom. The NIH cautions patients not to rely on a diagnosis of disease by an acupuncturist who lacks substantial training in conventional medicine.
Conditions treated with acupuncture
Acupuncture is commonly used to relieve chronic and acute pain. Conditions commonly treated with this procedure include:
Back pain and neck pain, including herniated discs and osteoporosis
Migraines and other headaches
Arthritis, including osteoarthritis and rheumatoid arthritis
Cancer pain and side effects from treatment
Dental pain, orofacial painand TMJ disorder
Nerve conditions such as sciatica, complex regional pain syndrome, paresthesia, Bell’s palsy (facial paralysis), phantom limb pain, neuralgia and neuropathy
Gynecological and pelvic pain (e.g., menstruation, labor, hot flashes)
Prostate disorders such as benign prostatic hyperplasia and prostatitis, and hot flashes resulting from hormone therapy for prostate cancer
Abdominal pain due to gastrointestinal disorders such as gastritis, ulcers or irritable bowel syndrome
Carpal tunnel syndrome
Chronic musculoskeletal pain disorders such as fibromyalgia, myofascial pain syndrome, chronic fatigue syndrome and myositis
Acupuncture may also be used as a form of anesthesia in high-risk patients or patients who have previously experienced adverse reactions to anesthetics.
A number of studies are being conducted on acupuncture. This research will likely uncover a number of additional areas in which acupuncture may be useful.
Before, during and after acupuncture
Acupuncture typically takes place in an outpatient setting, such as a clinic or physician’s office. During the initial visit the practitioner will collect the patient’s medical history to determine possible contributing factors. The practitioner will discuss the patient’s area of complaint, current medical condition, lifestyle and behavior. Patients should inform the acupuncturist of medications and additional treatments being used for the condition, particularly for pain.
A physical examination will then be performed to assess the patient’s status. In traditional Chinese medicine (TCM) practitioners often examine a patient’s tongue for abnormalities in shape, color and coating. The color and texture of the skin may also be noted, in addition to the patient’s posture. The acupuncturist will measure the patient’s pulse at several points along the wrist. Posture, pulse rate and the condition of the tongue and skin are believed to provide clues to a person’s health. Information collected during the medical history and findings from the physical exam will determine the acupuncture points that will receive stimulation.
After the examination, the patient will be asked to lie on a table. Depending on where the needles are going to be placed, patients may be told to lie on their back or on their stomach. They may also be instructed to loosen or remove some clothing. This allows the patient to get comfortable and uncovers areas that will be treated.
The acupuncture points are then sterilized with alcohol or another disinfectant. Disposable, one-time-use, sterilized needles are required by law in most states. These needles are inserted at specific points in the body. Patients may require anywhere from one or two needles to 20 needles. Usually fewer than a dozen needles are inserted. The number of needles required is based on the condition being treated.
Each needle is twirled or gently jiggled as it is placed to achieve the correct stimulation. They may be placed just under the skin or as deep as three inches (eight centimeters). The depth each needle is inserted is dependent on the location on the body and the condition being treated.
The needles are not necessarily placed in the area of pain. For example, pain or problems noted in the liver may use an acupuncture point in the leg or foot. Also, placement in one area often stimulates feeling in another part of the body.
Most patients feel no pain or minimal discomfort as the needles are inserted. Patients may feel a pinch or sting accompanied by a sensation of warmth or tingling. However, this minor discomfort should last only a few seconds. Patients should notify the acupuncturist if the pain persists.
Acupuncture needles can be left in place for a few minutes or up to an hour. For some treatments, the acupuncturist may insert and remove the needle for stimulation rather than leave it in place. In most cases, however, the needles are left in place for 15 to 30 minutes.
During this time, the acupuncturist will periodically check the patient’s comfort level. The practitioner may also move or manipulate the needles to stimulate the acupressure points. Many people find the treatment to be energizing, whereas others have reported a relaxing effect.
At the end of the session, the acupuncturist quickly and painlessly removes each needle. The one-time-use needles commonly used in the treatment will be disposed.
Depending on the condition being treated, the acupuncture needles may be heated, incorporating thermotherapy. A technique known as moxibustion requires the acupuncturist to light a small bunch of dried herbs (moxa). The herbs are then held above the needles without touching the skin. The moxa, which consists of the herb mugwort, burns slowly, releases a small amount of smoke, and produces an incense-like odor. Warm moxa also may be applied directly to the skin instead of needles for stimulation.
In some cases, electrical wires may be attached to the acupuncture needles, incorporating electrical therapy. A weak current is then sent to the needles to stimulate the acupuncture points. This can cause a mild tingling or no sensation at all.
After an acupuncture treatment, patients often feel more relaxed than usual. It is also common for patients to note a general change in appetite, bowel or urination habits and sleep patterns. This is thought to be related to having energy redirected and flowing more freely in the body.
An initial acupuncture session typically lasts an hour and a half, with weekly or biweekly follow-up sessions lasting 30 minutes to an hour. Treatment may take place over a few days, several weeks or longer. Patients with a single condition usually require six to 12 sessions spread out over several months.
Patients and their acupuncturist will decide the number of treatments required and the frequency of sessions. The number of sessions required is often based on the patient’s overall health and the condition being treated. Long-standing and complicated conditions often require more sessions. Patients taking certain medications (e.g., corticosteroids, tranquilizers, antidepressants) may also require more sessions.
Patients should ask the acupuncturist about the number of sessions required for their particular condition before starting the treatment. There have been cases of patients getting many treatments with minimal or no improvement.
Patients respond differently to acupuncture. Some patients report an immediate and strong effect after treatment, whereas others with the same disease or symptom may not notice a difference until several sessions have been conducted. In addition, many people who try acupuncture report no effect.
Potential benefits and risks with acupuncture
As with most medical treatments, there a number of benefits and risks associated with acupuncture. Potential benefits include:
Pain relief. Acupuncture can ease and control numerous types of pain.
Symptom relief. Treatment can reduce symptoms or side effects associated with medical conditions. For instance, many cancer patients report less nausea and fatigue from chemotherapy and radiation treatments when receiving acupuncture.
Safety. Acupuncture is a relatively safe procedure when performed properly.
Versatility. Acupuncture can be used alone or as a compliment to other treatment methods, such as physical therapy or biofeedback. It is also an alternative for patients who do not respond or do not wish to take pain medication.
Availability. Acupuncture is becoming increasingly more accessible in Western medical settings.
Potential risks associated with acupuncture include:
Failure of treatment. Acupuncture does not work for all patients.
Bleeding. There is a risk of minor bleeding associated with acupuncture. People with bleeding disorders and those taking anticoagulants are advised not to use acupuncture because of this risk.
Soreness or pain. This may result from improper needle placement, movement of the patient or a defect in the needle.
Organ punctures. If delivered improperly, acupuncture can result in puncture of an organ.
Infection. Patients may develop an infection as the result of inadequately sterilized needles.
Transmission of an infectious disease. As with all procedures involving the use of needles, acupuncture carries a risk of transmitting an infectious disease.
Broken needles. There is a small risk that an acupuncture needle may break, leaving a piece of metal imbedded in the skin.
Forgotten needles. There is a slight risk that a practitioner may accidentally leave an acupuncture needle in the skin at the end of a treatment session.
Patients can dramatically reduce these risks by seeking treatment from a qualified, certified and experienced practitioner.
Questions for your doctor about acupuncture
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or acupuncturist the following questions about acupuncture:
Can acupuncture help my condition?
Will I feel any pain from acupuncture?
What are the potential risks of acupuncture for me?
How can I find a qualified, certified and experienced acupuncturist?
Do you recommend any practitioner or facility in particular?
How many treatments will I require?
How long will each session take?
What can I expect in an acupuncture session?
Can I take medicine or receive other treatments at the same time?
Which of my conditions can be treated with acupuncture?
How do I know the needles are sterile?
How long will it take for me to see if acupuncture is helpful or not useful for me?
